中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
12期
727-730
,共4页
张玉霄%卢才义%周圣华%薛桥%高磊%田进文%高伟%陈瑞%翟金月%李丽君
張玉霄%盧纔義%週聖華%薛橋%高磊%田進文%高偉%陳瑞%翟金月%李麗君
장옥소%로재의%주골화%설교%고뢰%전진문%고위%진서%적금월%리려군
急性冠脉综合征%老年%经皮冠状动脉介入术%替罗非班%预后
急性冠脈綜閤徵%老年%經皮冠狀動脈介入術%替囉非班%預後
급성관맥종합정%노년%경피관상동맥개입술%체라비반%예후
Acute coronary syndrome%Elderly%Percutaneous coronary interrvention%Tirofiban%Prognosis
目的 评价国产替罗非班对老年急性冠脉综合征(ACS)接受经皮冠状动脉介入治疗(PCI)患者近期和远期预后的影响.方法 选择接受PCI治疗的325例年龄≥60岁的ACS患者,根据是否使用替罗非班分为替罗非班组(210例)和对照组(115例).两组患者术中均植入药物洗脱支架,口服阿司匹林+氯吡格雷;替罗非班组在此基础上加用替罗非班.比较两组基线资料,支架植入即刻心肌梗死溶栓血流(TIMI)3级的比例,支架内血栓发生率,轻微出血、大出血和血小板减少发生率,术后30 d和12个月的病死率、心肌梗死(心梗)和靶血管血运重建(TVR)的发生率.结果 替罗非班组PCI后即刻TIMI血流3级的比例高于对照组(99.05％比94.78％,P＜0.05),支架内血栓发生率明显低于对照组(0.47％比2.61％,P＜0.05)；替罗非班组术后30 d和12个月病死率、心梗和TVR发生率明显低于对照组(30 d:0、0.47％、0.47％比2.61％、3.48％、2.61％;12个月:0、0.47％、0.47％比2.61％、5.22％、5.22％,P＜0.05或P＜0.01)；替罗非班组轻微出血发生率高于对照组,但差异无统计学意义(7.14％比4.35％,P＞0.05)；两组均无大出血病例；替罗非班组血小板减少发生率较对照组有所升高(0.95％比0,P＞0.05).结论 国产替罗非班可明显改善老年ACS患者PCI术后即刻TIMI血流状况,有效降低支架内血栓发生率,减少术后30 d和12个月的病死率及心梗和TVR发生率,且不增加大出血和血小板减少的发生,从而改善患者的近期和远期预后.
目的 評價國產替囉非班對老年急性冠脈綜閤徵(ACS)接受經皮冠狀動脈介入治療(PCI)患者近期和遠期預後的影響.方法 選擇接受PCI治療的325例年齡≥60歲的ACS患者,根據是否使用替囉非班分為替囉非班組(210例)和對照組(115例).兩組患者術中均植入藥物洗脫支架,口服阿司匹林+氯吡格雷;替囉非班組在此基礎上加用替囉非班.比較兩組基線資料,支架植入即刻心肌梗死溶栓血流(TIMI)3級的比例,支架內血栓髮生率,輕微齣血、大齣血和血小闆減少髮生率,術後30 d和12箇月的病死率、心肌梗死(心梗)和靶血管血運重建(TVR)的髮生率.結果 替囉非班組PCI後即刻TIMI血流3級的比例高于對照組(99.05％比94.78％,P＜0.05),支架內血栓髮生率明顯低于對照組(0.47％比2.61％,P＜0.05)；替囉非班組術後30 d和12箇月病死率、心梗和TVR髮生率明顯低于對照組(30 d:0、0.47％、0.47％比2.61％、3.48％、2.61％;12箇月:0、0.47％、0.47％比2.61％、5.22％、5.22％,P＜0.05或P＜0.01)；替囉非班組輕微齣血髮生率高于對照組,但差異無統計學意義(7.14％比4.35％,P＞0.05)；兩組均無大齣血病例；替囉非班組血小闆減少髮生率較對照組有所升高(0.95％比0,P＞0.05).結論 國產替囉非班可明顯改善老年ACS患者PCI術後即刻TIMI血流狀況,有效降低支架內血栓髮生率,減少術後30 d和12箇月的病死率及心梗和TVR髮生率,且不增加大齣血和血小闆減少的髮生,從而改善患者的近期和遠期預後.
목적 평개국산체라비반대노년급성관맥종합정(ACS)접수경피관상동맥개입치료(PCI)환자근기화원기예후적영향.방법 선택접수PCI치료적325례년령≥60세적ACS환자,근거시부사용체라비반분위체라비반조(210례)화대조조(115례).량조환자술중균식입약물세탈지가,구복아사필림+록필격뢰;체라비반조재차기출상가용체라비반.비교량조기선자료,지가식입즉각심기경사용전혈류(TIMI)3급적비례,지가내혈전발생솔,경미출혈、대출혈화혈소판감소발생솔,술후30 d화12개월적병사솔、심기경사(심경)화파혈관혈운중건(TVR)적발생솔.결과 체라비반조PCI후즉각TIMI혈류3급적비례고우대조조(99.05％비94.78％,P＜0.05),지가내혈전발생솔명현저우대조조(0.47％비2.61％,P＜0.05)；체라비반조술후30 d화12개월병사솔、심경화TVR발생솔명현저우대조조(30 d:0、0.47％、0.47％비2.61％、3.48％、2.61％;12개월:0、0.47％、0.47％비2.61％、5.22％、5.22％,P＜0.05혹P＜0.01)；체라비반조경미출혈발생솔고우대조조,단차이무통계학의의(7.14％비4.35％,P＞0.05)；량조균무대출혈병례；체라비반조혈소판감소발생솔교대조조유소승고(0.95％비0,P＞0.05).결론 국산체라비반가명현개선노년ACS환자PCI술후즉각TIMI혈류상황,유효강저지가내혈전발생솔,감소술후30 d화12개월적병사솔급심경화TVR발생솔,차불증가대출혈화혈소판감소적발생,종이개선환자적근기화원기예후.
Objective To examine if tirofiban may improve the prognosis in aged acute coronary syndrome(ACS)patients received percutaneous coronary intervention(PCI).Methods Three hundred and twenty-five ACS patients(age ≥60 years),all received drug-eluting stents implantation,were assigned into tirofiban group(n =210)to receive tirofiban+aspirin and clopidogrel and control group(n=115)to received aspirin and clopidogrel only.The incidence of thrombolysis in myocardial infarction(TIMI)grade 3 after PCI,in-stent thrombosis,slight/severe bleeding,platelet decrease,myocardial infarction(MI)and target vessel revascularization(TVR)within 30 days and 12 months after PCI and 30 days and 12 months mortality post PCI.Results In comparison with the control group,the tirofiban group had significantly higher TIMI grade 3 flow after PCI(99.05％ vs.94.78％,P＜0.05),lower in-stent thrombosis(0.47％ vs.2.61％,P＜0.05),as well as lower mortality,MI,and TVR in 30 days and 12 months after PCI(30 days:0,0.47％ and 0.47％ vs.2.61％,3.48％ and 2.61％; 12months:0,0.47％ and 0.47％ vs.2.61％,5.22％ and 5.22％,P＜0.05 or P＜0.01).No significant difference was found(both P＞0.05)in slight bleeding (7.14％ vs.4.35％)and severe bleeding(0 vs.0)between tirofiban group and control group.A slight difference in thrombocytopenia was found between tirofiban group and control group(0.95％ vs.0),but it failed to reach the level of statistical significance(P＞0.05).Conclusions Tirofiban may improve the TIMI grade flow in senior ACS patients after PCI.It also decreases the incidence of in-stent thrombosis,mortality,MI,and TVR in 30 days and 12 months after PCI,without causing increase in severe bleeding and plateletpenia.Therefore,it may improve the short/long-term prognosis for these patients.
